This application is for a Midcareer Investigator Award in Patient-Oriented Research (K-24) for Tina Raine- Bennett, M.D., M.P.H., an Associate Professor of Obstetrics, Gynecology and Reproductive Sciences at UCSF. Early unintended pregnancies have significant consequences and occur at disproportionately higher rates in young, poor, uneducated, and minority women. The overall goals of this proposal are to: 1) To lay the ground work for conducting a high-quality, large-scale, theory driven intervention to improve contraceptive use and reduce unintended pregnancy rates among young, low-income, and minority women receiving care at family planning clinics; and 2) Engage fellows and junior faculty in the development of patient oriented research to improve contraceptive use behavior among women at high-risk for unintended pregnancy. Formal training in health services research methods through a Robert Wood Johnson (RWJ) Clinical Scholars post-doctoral fellowship and a Mentored Minority Medical Faculty Development Award provided skills and experience to become an independent investigator and build a productive research agenda in patient-oriented research. Principal findings from the analysis of data from my current NICHD-funded longitudinal cohort study of teens and young women who initiate hormonal contraceptives will provide the guiding concepts that will determine the content of a multi-component, clinic-based intervention aimed at multiple relevant modifiable factors. The dataset will form the basis of the qualitative analyses in the research plan and will serve as a key teaching tool for fellows needing to learn epidemiological research skills. We will perform primary and secondary analyses examining individual-level data (demographic, personal, and reproductive characteristics) as well as a wide range of information on contextual factors such as relationships, family, peer and community norms that influence contraceptive method choice and continuation. This will be followed by formative qualitative work and pilot studies to develop a relevant and operationally feasible intervention. The work in this proposal is intended to bridge the gap between collecting observational behavioral data and implementing theory driven patient oriented research to modify behaviors. The K24 award will strengthen my scholarly potential and contribution by expanding the scope of my current patient oriented research and allowing me to focus more explicitly and directly on mentoring and developing beginning investigators in patient-oriented research in family planning. PUBLIC HEALTH RELEVANCE: Little is known about interventions that work to improve contraceptive use and decrease unintended pregnancy. Information that can be obtained from high-quality clinical trials will be generalizable and provide evidence based guidance for providers in public clinic settings. It is important to mentor the next generation of obstetricians and gynecologist trained in epidemiologic research and clinical trials methodology.